The open enrollment period for the School Employees Health Benefits Program (SEHBP) has begun and will run through Oct. 31.  The Division of Pensions and Benefits has updated its website to include premium levels for the existing plan options as well as the recently created “zero copay” plans.

The following webpage contains information on all the medical plans available to active employees enrolled in the SEHBP including a summary of benefits and coverage for each option, the rates for each plan, and updated employee premium contribution calculators and worksheets:

2019 Plan Year Information

Due to action taken by the SEHBP Plan Design Committee last month, premiums under the program have declined for the first time in recent memory. Premiums for active employees will drop by 1.1 percent in 2019 compared to the current plan year.

As previously reported in School Board Notes, the SEHBP now includes two new “zero copay” plans, NJ DIRECT ZERO and Aetna Freedom Zero, which carry costs that are significantly lower than the plan currently selected by most active employees (NJ DIRECT 10). For example, the monthly premium for family coverage (medical and prescription drug) under NJ DIRECT 10 will equal $3,159.  For the same coverage tier under NJ DIRECT ZERO, monthly premiums will total $2,608. Click here for a comprehensive list of all SEHBP plan options and their corresponding costs.

The two new plans are designed to encourage the use of in-network primary and specialty care services by eliminating co-payments from members while lowering the cost to employers. Savings are expected to be achieved through out-of-network payment reforms and the increased use of generic drugs. The plans also carry an enhanced NJWELL incentive that will provide a $500 gift card to employees and their covered spouses who participate in the wellness program (the incentive remains $250 for all other SEHBP plans).

Migration of active employees and their dependents from their current plans into NJ DIRECT ZERO and Aetna Freedom Zero will result in meaningful financial savings for both school districts and employees. The state estimates that school districts will save approximately $23 million should 10 percent of current enrollees switch from their existing coverage to either of the new plans.